The United Nations Office on Drugs and Crime (UNODC) is partnering with the Ministry of Health in Malawi to support the Malawi Prison Service (MPS) conduct cervical cancer screening for all female prisoners throughout the country.
In 2017 the Malawi Medical Journal reported that Malawi had the highest age standardised rate of cervical cancer in the world. The peer-reviewed publication also reported, also, that cervical cancer accounted for over 40 percent of cancers affecting women in Malawi.
Although cervical cancer can be prevented through cervical screening and the use of Human Papilloma Virus (HPV) vaccines, experts say knowledge and uptake of these measures are low, particularly in prison settings. For the first time in Malawi, screening for cervical cancer among female prisoners began last Tuesday, according to Henry Ndindi, a medical doctor who is UNODC Malawi Country Coordinator.
Malawi has 30 prison institutions and approximately 14,300 inmates, more than double the carrying capacity of the country’s correctional facilities. The screening is being extended, also, to female prison officers and spouses of male prison officers. The Malawi Prison Service has a work force of 3620 officers. Of these, 700 are female. Part of UNODC’s work seeks to strengthen the capacity of national governments to put in place legal, policy and strategy instruments that adhere to UN Minimum standards for Sexual and Reproductive Health Rights (SRHR), HIV and AIDS for prison populations.
The UN agency helps to build national capacity to adopt or adapt and implement measures necessary for adherence to SRHR, HIV and AIDS minimum standards for women and adolescent prisoners.International standards that include the Nelson Mandela Rules support the provision of the same standards of health care in prisons as are available in communities. The Nelson Mandela Rules encourage member states to offer prisoners health care services free of charge and without discrimination. Similarly, the United Nations Rules for the Treatment of Women Prisoners and Non-custodial Measures for Women Offenders – popularly known as the Bangkok Rules of 2010 - encourage screening of all female prisoners for reproductive health related issues.
Additionally, Sustainable Development Goal 3 exhorts member states to ensure healthy lives and promote wellbeing for all at all ages. However, in many countries that include Malawi, prisons still experience challenges in providing appropriate and adequate health services to prisoners who form part of key populations who bear a disproportionate burden of most diseases. A study commissioned in 2011 revealed that female prisoners in prisons located in the central part of Malawi had an HIV prevalence of 42 percent. This was also associated with high levels of Syphilis. This screening forms part of UNODC’s efforts to take health services closer to hard-to-reach and often underserved populations.
The Malawi National Cervical Cancer Control Strategy recommends cervical cancer screening for every woman aged between 30 and 49 years at least once in their lifetime. It is in this context that UNODC is supporting the screening services through the Ministry of Health. The main aim is to ensure access to diagnosis of all precancerous lesions or cancer for appropriate management and referral for confirmed cancer cases among female prisoners, female prison officers and spouses of male officers in Malawi Prison Service.
UNODC is bearing the costs associated with this screening while providing logistical support to service providers who are from the Ministry of Health. More broadly, the UN agency is supporting efforts to integrate prison and public health given severe human resources-related challenges that the Malawi Prison Service is grappling with. The screening is expected to be completed by the 4th of May 2019. Approximately 1000 women stand to benefit from this unprecedented intervention.
Already, expectations are running high. Twambilire Phiri, the Chief Reproductive Officer in the Ministry of Health in Malawi, said there were only about 250 female inmates in Malawi, who, like everyone else, deserve the best possible health care. Phiri said that this nationwide screening for cervical cancer specifically targeting female inmates was proof that human rights are not about numbers. “Some people might say that female prisoners are very few in Malawi. Even if there was only one female prisoner, this screening would be necessary.
We do not wish women to be prisoners because they are the hubs of families. Putting them in prison leads to so much suffering of all those who depend on them,” Phiri said. She revealed that the Cervical Cancer Programme in Malawi is donor-driven. “We rely on partners. Our mission is to provide strategic leadership for the delivery of a comprehensive range of quality, equitable and efficient health services to all people in Malawi. UNODC has released funds which made it possible for us to offer these services,” she said. From neighboring Zambia, Dr Christopher Kalila, a Member of Parliament, medical practitioner and advocate for good prison health, was effusive in his praise for this screening.
“This is a major milestone in prison health. It’s a perfect example of not leaving anyone behind as espoused by Sustainable Development Goals and recognising the rights of marginalised groups in our society,” he gushed. He added: “We only wish other African Governments could take similar steps in scaling up SRHR interventions like cervical cancer screening to all population groups. Moses Magadza is Communications Officer for UNODC Regional Office for Southern Africa.